Acute quadriceps compartment syndrome and rhabdomyolysis in a weight lifter using high-dose creatine supplementation.

Creatine, a nutritional supplement marketed to increase strength and muscle mass, is the most profitable performance-enhancing agent used among athletes today, grossing more than $200 million in 1998. As its use increases, especially among highschool athletes, the concern about its safety mounts. Because creatine is a dietary supplement, it is not regulated by the Food and Drug Administration, and distributors are not required to give any specific dosing recommendations. Researchers recommend a loading dose of 20 to 25 gld for 5 to 7 days followed by a maintenance dose of 2 to 5 gld for oral supplementation. Although studies investigating the benefits of creatine report no evidence of side effects, most of these studies observed patients only during the loading period. A few studies observed patients during the maintenance period, but the longest study lasted only 10 weeks. There are no studies investigating the side effects of creatine supplementation beyond 10 weeks or with higher maintenance doses. Many distributors and sources in the popular media advocate a higher dose than recommended. Furthermore, a survey by Juhn and colleagues found that 39 of 52 athletes who supplemented their diets with creatine exceeded the recommended maintenance dose. The following case of a weight lifter who developed acute compartment syndrome raises suspicion regarding the safety of high-dose, long-term creatine use.